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Can you take Exenatide with Zoledronic acid?

1 drug interaction and 11 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

zoledronic acid exenatide

Applies to: zoledronic acid and exenatide

Exenatide may rarely cause kidney problems, and combining it with other medications that can also affect the kidney such as zoledronic acid may increase that risk.

Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications.

You should seek immediate medical attention if you develop signs and symptoms that may suggest kidney damage such as:

  • nausea
  • vomiting
  • loss of appetite
  • increased or decreased urination
  • sudden weight gain or weight loss
  • fluid retention
  • swelling
  • shortness of breath
  • bone pain
  • muscle cramps
  • tiredness
  • weakness
  • dizziness
  • confusion
  • irregular heart rhythm

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

exenatide Food/Lifestyle

Applies to: exenatide

You should take exenatide twice a day, at any time within the 60 minutes (1 hour) before your morning and evening meals, or before the two main meals of the day, and at least 6 hours or more apart.

You may experience decreased absorption of exenatide in the presence of food or other medications.

Your other medications should be administered at least 1 hour before or 2 hours after your exenatide injection.

Disease interactions

10 potential interactions Applies to: 8 conditions, including Vitamin D Deficiency, Asthma, Hypocalcemia, Pancreatitis, and Kidney Transplant.

Asthma

Moderate:

zoledronic acid

Zoledronic acid has a moderate potential interaction with Asthma.

There have been reports of bronchoconstriction in aspirin-sensitive patients receiving bisphosphonates. Use of these agents in asthmatic and in aspirin-sensitive patients should be used with caution.

Hypocalcemia

Major:

zoledronic acid

Zoledronic acid has a major potential interaction with Hypocalcemia.

The use of bisphosphonates is contraindicated for the treatment of osteoporosis in patients with hypocalcemia. These agents increase bone mineral density, a process that requires an adequate supply of calcium in the body. Following the initiation of therapy, a short-term reduction in serum calcium and phosphate levels usually occurs due to inhibition of bone resorption, especially in patients with Paget's disease, in whom the pretreatment rate of bone turnover may be greatly elevated. Hypocalcemia and other disturbances of mineral metabolism, such as vitamin D deficiency, should be treated prior to initiation of therapy. Appropriate intake of calcium and vitamin D should be ensured throughout the course of treatment.

Infection

Major:

zoledronic acid

Zoledronic acid has a major potential interaction with Infection.

Osteonecrosis of the jaw (ONJ), which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients taking bisphosphonates. Known risk factors for osteonecrosis of the jaw include invasive dental procedures (e.g., tooth extraction, dental implants, boney surgery), diagnosis of cancer, concomitant therapies (e.g., chemotherapy, corticosteroids, angiogenesis inhibitors), poor oral hygiene, and co-morbid disorders (e.g., periodontal and/or other pre-existing dental disease, anemia, coagulopathy, infection, ill-fitting dentures). The manufacturers of bisphosphonates recommend discontinuation of bisphosphonate treatment for patients undergoing invasive dental procedures. Patients who develop osteonecrosis of the jaw while on bisphosphonate therapy should receive care by an oral surgeon. In these patients, extensive dental surgery to treat ONJ may exacerbate the condition. Discontinuation of bisphosphonate therapy should be considered based on individual benefit/risk assessment.

Kidney Transplant

Major:

exenatide

Exenatide has a major potential interaction with Kidney Transplant.

Exenatide should not be used in patients with severe renal impairment (CrCl <30 mL/min) or end-stage renal disease, and should be used with caution in patients with moderate renal impairment and renal transplantation.

Multiple Endocrine Neoplasia Type II

Major:

exenatide

Exenatide has a major potential interaction with Multiple Endocrine Neoplasia Type II.

GLP-1 receptor agonist antidiabetic drugs are contraindicated in patients with a personal or family history of medullary thyroid carcinoma and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN2). Carcinogenicity studies in rodents and limited postmarketing data suggest that GLP-1 inhibitors may cause a dose-related and treatment duration-related increase in risk of thyroid C-cell tumors, although a causal relationship has not been established.

Pancreatitis

Major:

exenatide

Exenatide has a major potential interaction with Pancreatitis.

The use of GLP-1 receptor agonists has been associated with rare reports of acute pancreatitis. Other antidiabetic therapies should be considered in patients with a previous history of pancreatitis, although it is not known if they are at increased risk. Patients receiving treatment with GLP-1 receptor agonists should be observed carefully for signs and symptoms of pancreatitis. If this diagnosis is suspected, the treatment should be discontinued immediately and appropriate management should be initiated. Treatment with GLP-1 receptor agonists should be permanently discontinued if pancreatitis is confirmed.

Renal Dysfunction

Major:

exenatide

Exenatide has a major potential interaction with Renal Dysfunction.

Exenatide should not be used in patients with severe renal impairment (CrCl <30 mL/min) or end-stage renal disease, and should be used with caution in patients with moderate renal impairment and renal transplantation.

Major:

zoledronic acid

Zoledronic acid has a major potential interaction with Renal Dysfunction.

Zoledronic acid injection is contraindicated in patients with creatinine clearance less than 35 mL/min and in those with evidence of acute renal impairment. No dosage adjustment is required in patients with a creatinine clearance of greater than or equal to 35 mL/min. Creatinine clearance should be calculated based on actual body weight using Cockcroft-Gault formula before each zoledronic acid injection dose. Acute renal failure (ARF) has been observed in patients after a single administration. If history or physical signs suggest dehydration, zoledronic acid injection therapy should be withheld until normovolemic status has been achieved. Zoledronic acid injection should be used with caution in patients with chronic renal impairment. Consider monitoring creatinine clearance in patients at-risk for ARF who are taking concomitant medications that are primarily excreted by the kidney.

Moderate:

exenatide

Exenatide has a moderate potential interaction with Renal Dysfunction.

There have been reports of acute renal failure and worsening of chronic renal failure sometimes requiring hemodialysis in patients treated with GLP-1 receptor inhibitors. Some of these events occurred in patients without known underlying renal disease. These drugs should be used with caution in patients with renal impairment, especially during treatment initiation or dose escalation. Patients should be monitored, especially if they report severe gastrointestinal reactions such as nausea, vomiting, diarrhea, or dehydration. The frequency of gastrointestinal events is increased as renal function declines. There is limited clinical experience with most of these drugs in patients with severe renal impairment.

Vitamin D Deficiency

Major:

zoledronic acid

Zoledronic acid has a major potential interaction with Vitamin D Deficiency.

The use of bisphosphonates is contraindicated for the treatment of osteoporosis in patients with hypocalcemia. These agents increase bone mineral density, a process that requires an adequate supply of calcium in the body. Following the initiation of therapy, a short-term reduction in serum calcium and phosphate levels usually occurs due to inhibition of bone resorption, especially in patients with Paget's disease, in whom the pretreatment rate of bone turnover may be greatly elevated. Hypocalcemia and other disturbances of mineral metabolism, such as vitamin D deficiency, should be treated prior to initiation of therapy. Appropriate intake of calcium and vitamin D should be ensured throughout the course of treatment.

More resources

exenatide

A total of 426 drugs are known to interact with exenatide.

zoledronic acid

A total of 129 drugs are known to interact with zoledronic acid.

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.